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HomeMy WebLinkAbout05-12-09N W 11J _ ]C -~ Z D a ° ~ o ~ cv N ani ~ ~ REV-1737-A EX (608) Pennsylvania / ~ ' INHERITANCE TAX RETURN ~ i - - E DEPARTMENT OF REVENUE PO BOXz8o6oi NONRESIDENT DECEDENT FIL U BER pg ~ HARRISBURG, PA 1')128-0601 COUNTY CODE YEAR NUMBER ~ DECEDENTS NAME (LAST, FIRSTAND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z PLANTE, ARCADE J. 347-16-4839 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) W 07/30/2000 05/17/1923 V W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ GENEVIEVE PLANTE 341-12-3207 F ~ 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (deteordeetn pnorto tz-t3-sz) w a ~ ^ 4. Limited Estate ©4a. Future Interest Compromise (date or deecn after ~2-tz-es> ^ 5. Federal Estate Tax Retum Required =oo ~ a m ~ 6. Decedent Died Testate (Attach copy or wap ^ 7. Decedent Maintained a Living Trust (Attach copy or Trust> 0 8. Total Number of Safe Deposit Boxes a `t ^ 9. Litigation Proceeds Received ^ 1 O. SpoUSal POVerty Credlt (date of death between 12-31.91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Atlach sch o> ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS z 0 JAMES D. HUGHES, ESQUIRE 4 X S ~ ~ FIRM NAME pfApp~icable) SALZMANN HUGHES, P.C. 35 ALE ANDER SUITE 1 PRING ROAD p TELEPHONE NUMBER CARLISLE, PA 17015 717 249-6333 IETHOD REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736) Check One: ^ Flat Rate ^ Proportionate (Complete Worksheet on Reverse Side) 1. Real Estate (Schedule A) (1) 93,500.00 2. Stocks and Bonds (Schedule B) (2) r`'~ ~:~ . Closely Held Corporation, Partnership or Sole-Proprietorship (3) ,,-~ - C7 ~ ::o ~, ;a - ~ - (Schedule Cj = - ~~ ~ ---~ --< 4. Mortgages 8 Notes Receivable (Schedule D) (4) - - t r-, ._.. - 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) - - N -, O (Schedule E) ~ ~ ~ `} - ~ 6. Jointly Owned Property (Schedule F) (6) - J =~ , ^ Separate Billing Requested ---t j ~~ -~ CJ1 ~ ~ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (1) - ~ (Schedule G or L) d. V 8. Total Gross Assets (total Lines 1-7) (g) 93,500.00 W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1, 303.00 ~ 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 1,303.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 92,197.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 92,197.00 ~ Z SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES _ ~ 15. Amount of Line 14 taxable at the spousal tax 92,197.00 x 0 0 (15) 0.00 Y ~ rate, or transfers under Sec. 2116 (a)(1.2) W ~ a 16. Amount of Line 14 taxable at lineal rate x .0 _ (16) = V ~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) 0 (.) 18. Amount of Line 14 taxable at collateral rate x .15 (18) REV-1737-2 EX + (6-06) (FI) Pennsylvania DEPARTMENT OFREVENUE INHERTIANCE TAX RETURN NONRESIDENT DECEDENT SCI~IEDULE A, PART 1 REAL ESTATE IN PENNSYLVANIA ESTATE OF FILE NUMBER ARCADE J. PLANTE 99-09 Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its situs in Pennsylvania. Property jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate must be reported at fair market value, which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell and both having reasonable knowledge of the relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t . Real Estate situate at 41 E. South Street, Borough of Carlisle, Cumberland County, Pennsylvania (See HUD-1 attached) PART 1 TOTAL From reverse side.) ~ $ TOTAL (Also enter on Line 1, Recapitulation) ~ $ (If more space is needed, use additional sheets of paper of the same size) 93,500.00 93, 500.00 93,500.00 REV-1737-6 EX + (6-08) REVERSE pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & Use Schedule H ONLY for proportionate method of tax computation. ADMIN151'RATIVE COSTS ESTATE OF FILE NUMBER Arcade J. Plante 99-09 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commission(s) Name(s) of Personal Representative(s) (Submit requested information for additional personal representative's on additional sheets) Social Security Number(s) or EIN Number(s) of Personal Representative(s) Street Address(es) City(ies) State(s) ZIP(s) Year(s) Commission Paid 2. ~ Attorney Fees Salzmann Hughes , P . C . 3. I Probate Fees 4. ~ Accountant's Fees 5. Tax Return Preparer's Fees 8. Miscellaneous Expenses 1,000.00 303.00 1,303.00 TOTAL {Also enter on Line 9, Recapitulation.) $ (If more space is needed, use additional sheets of paper of the same size) REV-1737-7 EX + (6-0A) REVERSE pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Arcade J. Plante 99-09 When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. RELATIONSHIP TO ITEM DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j, TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 2116 (a)(1.2)] 1. Genevieve Plante Spouse 92,197.00 1165 Yale Avenue Bourbonnais, IL 60914 Life Estate under Clause Six of the Will Pursuant to Section 72PS SS 9113 Trusts for Spouses ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II (Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) (If more space is needed, use additional sheets of paper of the same size) ~~~ zZ~ ~~~ C~.l^~.~~xrrr~rt.~ .a~ ARCADE J. PLANTS I, Arcade J. Plate, of 1165 Yale Avenue, Bourbonnais, Kankakee County, Illinois, declare this to be my last will and testament. Clause One I revoke all previous wills and codicils. Clause Two I am married and my spouse's name is Genevieve F. Plante. All references in this will to my spouse are to her. Clause Three I have one child now living, a son, Paul A. Plante, who resides at 41 East South Street, Caflisle, Pennsylvania. I have no deceased children. Clause Four I give all of my televisions and computers to my son, Paul A. Plante. I ~ivC Gil 3f lily JFiilriS anu recreational e~i.iipi7icnt t.7 my 5GP., Paul A. i~13:,tG, eXC:;~,t for my boats. I give my Hoff violin to Ruth LaMontange Schwartz, currently of 1135 South Poplar, Kankakee, Illinois. I give all of my automobiles and other tangible property of a personal nature to my spouse, if she survives me. Clause Five No person named or described in this Will shall be deemed to have survived me unless he or she is living on the thirtieth (30th) day after the day of my death. -; r ~~. ~ a- ~-<- ~' . `.~ E G~ ~ ~.Fa. <~ Clause Six 1 give the residue of my estate to the trustee named in this instrument in tnust, to be held and administered on the fallowing terms: A. If my spouse survives me the trustee shall pay the net income from the trust to my spouse until her death. B. The trustee shall pay no part of the principal of the trust to my spouse. C. For so long as my spouse desires to Live at 1165 Yale Avenue, Bourbonnais, Illinois, the trustee shall maintain said property from the income of the trust, said payments shall be considered income payments to my spouse and such payments shall include all maintenance on the house, payment of taxes, utilities, and all other charges attributable to the house. D. On the death of the survivor of my spouse the Trust shall continue and the Trustee shall pay the income from the Trust to my son, Paul A. Plante, during his life and upon his death, the remaining corpus and any undistributed income, after payment of al[ Trustee's fees and other expenses of administration, shall be divided equally between New Melleray Monastery Peosta Iowa and St. Vincent Arch Abbey La Trobe Pennsylvania and the 'Trust shall be terminated. ~. ~ 1d~~ Clause Seven a~~ Except as otherwise provided, the following provisions apply to the trust under this will: A. When any beneficiary entitled to receive payments in the absolute judgment of the trustee, is mentally or physically incompetent (irrespective of whether legally so adjudicated), the trustee may in the trustee's absolute discretion, expend ar apply any payments for the benefit of the beneficiary. B. Income of the trust estate actually collected but not distributed at the date of the termination of the trust will be payable, or credited, as income to the beneficiary entitled to the estate or interest in proportion to his, her, or their respective interest. If, prior to the final distribution of my estate to the trustee, any part of the net income from my estate has been paid by the executor to any person or persons designated in this instrument to receive any part of the trust net income, the death of the person prior to final distribution will not operate to confer any right to the income so paid on any beneficiary entitled to the next estate or interest. C. The proceeds from the sale or transfer (other than a leasing or letting) of any part of the trust property will be for the account of trust principal. Bonds or other obligations bearing no stated interest will constitute income, when sold or redeemed, to the extent of the profit realized by the trustee. ,i ~-~-: -f D. Until the trustee receives written notice of any birth, death, marriage, or other event on which the right to receive payments from the trust estate may depend, the trustee will. incur no liability for disbursements of principal or income made in good faith to any person whose interest may have been affected by that event. E. In making any division or distribution of the property of this trust, the trustee is authorized in the trustee's absolute discretion, to make any division or distribution among the respective beneficiaries at any valuation as the trustee deems fit and proper, and in the trustee's absolute discretion may distribute the trust property in cash or in kind to the beneficiary or beneficiaries then entitled to receive any part or all of the trust estate. The trustee is further empowered to sell any portion or portions of all of the trust estate and to take other steps as may be necessary or proper in the trustee's absolute discretion to effect any division or distribution. F. On or before each anniversary date of the inception of the trust, the trustee shall - account to the remainder beneficiary, i.e., Pau( A. Plante, if he is then surviving. The remainder beneficiary may approve all such accountings in substitution for court approval. G. In handling the trust estate, the trustee has the power: q~G -. ~ Z~OQ 1. To manage, invest, and reinvest the trust property without regard to lack.... of diversification; to borrow money, including borrowing from the trustee and to mortgage, convey in trust, pledge, or otherwise hypothecate and encumber the trust property; to grant options; to vote stock; and, to do and perform any and all other acts and things deemed by the trustee necessary or advisable in the management of the trust estate that may be done by an absolute owner of property. The trustee's powers will be cumulative and in addition to the powers conferred on the trustee by law. The enumeration here of the trustee's powers will not be construed as a limitation, it being my intent that at no time will the trustee be prevented through lack of an express power from taking any action in connection with the .trust estate which the trustee may deem expedient. 2. To acquire, except as prohibited by Iaw, every kind of property, real, personal or mixed, and every kind of investment specifically including, but not by way of limitation, corporate obligations of every kind, and stocks, preferred or common, including investment in common trust funds. 3. To continue to hold any and all property received by the trustee or subsequently added to the estate, or acquired by the trust estate pursuant to proper authority, so long as the trustee exercises the judgment and care under the circumstances then prevailing which persons of ordinary prudence, discretion and intelligence exercise in the management of their own affairs, not in regard to speculation but in regard to the permanent disposition of their funds, considering the probable income from these funds, as well as the probable safety of their capital. ~- i %- r 4. To allocate receipts and disbursements to principal or income as the trustee deems appropriate. In determining allocations between principal and income, all allocations made by the trustee in good faith will be conclusive. 5. As to property held at any time or from time to time as an asset of any trust under this instrument, the trustee cannot charge any depreciation to income. The cost of improvements cannot be amortized and no part of the improvements can be charged to income. The cost of ordinary repairs will be charged to income and the cost of extraordinary repairs will be charged to principal. Clause Eight If any beneficiary under this will contests it or any of its parts or provisions, any share or interest given to that person will be revoked and augment proportionately the shares of those beneficiaries who have not joined or participated in the contest. Clause Nine I appoint Genevieve F. Plante, my spouse, trustee of the trust created under this will to serve without bond. In the event for any reason my spouse is unwilling or unable to act as trustee, I name Alan F. Smietanski, my attorney, as trustee to serve without bond. Clause Ten I nominate and appoint Genevieve F. Plante, my spouse, executor of this will to serve without bond. In the event my spouse is unwilling or unable to act as executor, I name Paul A. Plante executor of this will. Clause Eleven Unless sooner terminated as otherwise provided in this instrument, the trust created here fully ceases and terminates 21 years after the death of the last survivor of the testator and ail children of the testator living on the date of this will. On termination, the entire principal of the trust estate, together with any undistributed income, will vest in ar~d be distributed to the .<--p~~ur}s.entitled to take under the provisions of the trust. We certify that in our presence on the date appearing above, Arcade J. Plante signed the foregoing instrument and acknowledged it to be his Will, that at his request and in his presence and 4 in the presence of each other we have signed our names below as witnesses, and that we believe him to~f sound and m ' ory. y residing at ~ ~~. (~~h? ~ ~C ~ residing at _~~%~"1 , ~~, AFFIDAVIT OF WITNESSES STATE OF ILLINOIS ) SS: COUNTY OF KANKAKEE ) We, the testator and witnesses, respectively, whose names are signed to the att<~ched instrument, being first duly sworn, declare to the.undersigned authority that the testator, in the presence of witnesses, declared as his will the instrument of which this affidavit is a part; that the testator then freely and voluntarily signed such instrument as his will for the purposes therein expressed; that each of the witnesses believed the testator to be of legal age and sound mind and memory and under no constraint or undue influence of any land; and that each of the witnesses then attested the will at the testator's request and in the presence of the testator and of each other. /`~, ~ ~ l _ / .C_~-- / /-~~C j..- ess l C. Witness ~ SUBSCRIBED AND SWORN TO before me this 18th day of June, 1999. otary blic "QFFICIAL SEAL" 0 boo q ,}. HAMBY-MORROW NOTARY PUBLIC, STATE OF ILLINOIS ~ ~~~ ~OPiI'`~ISSfON EXPIRES 1OJ30~2001 ~ s A. :~°ttle'_ilent Statement B. rv'r, ,i Loan U.S. Department of Housing and Urban Development OMB Approval No. 2502-0265 (expires 11/30/2009) L CjFHA 2. ^FmHA 3. i_Conv Unins. i 6. File Number l~ 7. Loan Number 8. Mortgage Insurance Case Number j L 29664WOLF I __ _.-_.___- _l ~4 4 I_VA 5 ~Conv Ins - Fi] n l 1 re a d ~ ~ h " -_ _-~ w ement 9gen a s nL e sett i to a y t r TF sTphnisT 9Fit?d 1o give you a statement o acts seArrnent costs 7Cmdunl5 p it C. Note: Items marked (oo cl" were pad outside Ne closing: they are Shown here for information purposes and are not incl ded in the totals. TIteExpfeSS Settlement System Pe all es upon make false statements to the United Stales on This or any olhe similar form rime to knowin l RNING It . g y s a c WA : ___conviction can Inclutle a tine and imo[isonment. For details see: Ti11e i8 l1 S. Code Section t001 and Section tOtO. _____ _._ _ Pflnled 02/19120D9 of 11:12 CLT j I _ _ ' D NAME OF BORROWER: James W. Wolf,Jr. and Angela C..Wolf I ADDRESS,____ -._ ___ _ PO Box 894 Carlisle,__P_ a 17013 ___-__ _.-____ ____- ___-_- -__ _____. __ F-- i ENAME OF SELLER: Estate of Arcade J. Plante ~~ ~-_ ADDRESS:_---- -----___ --------- I F NAME OF LENDER: j ADDRESS__-._ ~' I, G PROPERTY ADDRESS: 41 E. South Street, Carlisle, PA 17013 ~ I __ Carlisle Borough _ _ __ ' -- ' H. SETTLEMENT AGENT: Cedar Cliff Abstract Agency, Inc., Telephone: 717.774-7435 Fax: 717-774-3869 _PLACE OF SETTLEMENT: 414 Bridge StreeiNew Cumberland, PA 17070 --- I _I SETTLEMENT DATE __._._..__0 211 912 0 0 9 - --- -T-- ---------- - --- -- BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: SUMMARY OF J - _ . 100_GROSS AMOUNT DUE-FROM BORROWER _ , ___ _ _ 400_GROSS AMOUNT DUE TO SELLER __ X01._ Contract sales_price-.___ ___ 93 500.00 401. Contract sales rice _ r _ 93,.500.0 - ~_ 102_Personal!?roperty,._-_____--_ 402. Personal Pro ert ~ ~__103__Settlement charges to_borro_wer line 1400)_ _-___.11735.50 403. _ 404. 104.---- - - --- ---- 11 -_ - 405. _. - 105. _ -1 I ----------- __ Adustments for items Paid by seller i~ vance -_ _- Adjustments for items paid b sellers in advance -- I I~ 106 _ Cityltown taxes- -_ -._ __.~__ ____ _- 406. Cit down taxes y 107. Coun! taxes__- 407, County taxes _-__ _-_ _ _ ___ 108. School ta.~es __- _ _ _0.2119109 to 06130109 ~ 370 73 408. School taxes 02119109 to 06/30109 370.73 . r 109 409,- - - . i ----- - 11D. ---- 410_ -- I - r 111 ~- _ 411. -- --_ 112 - --~ GROSS AMOUNT DUE FROM BORROWER _ : ____ 95 606 23 , 120 412_ - - ) 420. GROSS AMOUNT DUE TO SELLER _ I _ 93,870.73 - 200._AMOUNTg PAID BY OR ON BEHALF OF BORROWER ___.___ x_201. Deposit or earnest money___ ___ _ ~ _ 1 D00 00 1 500. REDUCTIONS IN AMOUNT DUE TO SELLER -- 501., _ Excess De osit see instructions __ _-T_ 1 000_00 I 6 887 05 202 Princpal amount of new loans _ __ _ __. _~_ _-_ I __- _ 203 ExistingloanL) taken subiect. to--_ _j_-_ . 502._ Settlement char es io seller (line 1400) -----9 - 503. Existin loan taken subiect to I ~ 1st---- - -, f 204- _ _____ - - 504. Pavoff of First Mortgage Loan ! __ I 205 ------ - _206._Re air Credit _ ~ 350.00 208. S-~_D__p_sits - - ___...__695.00 I 505_ 506-Repair Credit ~ 350 00 508. SecurityDeposits --- _- _--- -- 695.00 . 1209. ' -- - --L--- 509_.-- - - -------- i _ - _ Adjustments for_items unpaid by seller __ Citvltown taxes 210 -._ Ad•us1 tments for items unpaid b seller ' 510. Cit Itown taxes _ ___ _ _____, ___ . _211_County_taxes___. 01101109to02119109 _________54.08 511. Count taxes 01101109 to 02119109 _ 54.08 212,_School taxes __ ----- --1- ---- 512. School taxes _ _ i-- - 1213. I 13 _214. Rent Prtions 2119109-2/28!09 __- _________ 223.38 514. Rent Prtions 2119109-2128/09 223.38 215_- __ _ - 515. -~- ---- t 215,.--------- -- i i _217.'---- -- - -- 516. _ I 517__ - f 218 __ I --- - 518. -. 219 ______ __ __ ___ 2,322.46 TOTAL PAID BYIFOR BORROWER ~20 519_ f 620, TOTAL REDUCTION AMOUNT DUE SELLER _ 9,209.51 _ _ 300 CASH AT SETTLEMENT FROM OR TO BORROWER __ I 95 606,23 301 Gross amount due from borrower line 120 600. CASH AT SETTLEMENT TO OR FROM SELLE 601. Gross amount due to seller line 420) t R _ 93 870.73 _ ~3_02_Less amounts laid b-y/for borrowe_r_ line 220) _. ~ ___- 2 322.46 Iler line 520 602. Less reduction amount due se __,____ _9,209.51 i 303. CASH FROM BORROWER I~ 9.3,283.77 603. CASH TO SELLER __ 84 661.22 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is imDOrtant tax information and is being furnished to the Internal Revenue Service. If you are requ~retl to fie a return, a negligence penalty or other sanction will be imposed on you it This item is required lobe reported and the IRS tlelermines That it has not Deen reporetl. The Contract Sales Price describetl on Ilne 40t above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent (Fed. Tax ID No: )with your correct taxpayer itlen[ifcation number. If you do not provitle your correct taxpayer itlentiBCalion number, you maybe suD(ect l0 civil or criminal penalties imposed bylaw. UnderUnder penalUe~per(ury, I certiry that the number Shown on this Statement is my wmect Taxpayer itlentifcation number. TIN -_-- f _- SELLER(S)SIGNATURE(S): SELLER(S) NE W MAILING ADDRE SS'. SELLER(S) PHONE NUMBERS tR) U S. DEPARTMENT OF HOUSING ANU URBAN DEVELOPMEN 1 rue tvumoer: cywMrrv~r _ SET'~I,EMENT STATEMENT______ _ -______ ________ TitleExpress Sefllemern_5vstem Printed u2iiy12uti JF , L I ErJT CHARGES- __ ~ PAID FROM 7.00 TOTAL SALES/BROKER'S COMMISSION based on~rice $93,500 00 (~ 6.000 = 5,61. 0.00. ___ __ I BORROWER'S Division of wrrimisslon16ne 70tJ as follows __ __ _ _ _ ___ ^I FUNDS AT 701 $ _~ , _2,830 00 to RelMax Sterling_Associates, Inc. -~ SETTLEMENT - -- -- -- 702 $ __ __. -____ 2,780.00_ to Wolfe and Shearer Realtors ---------------- - 805. Lender's InspECtion_Fee __806,__ Mortgage Application Fe - --__ _ - PAID FROM SELLER'S FUNDS AT SETTLEMENT i a t 1 ~ I - --- - _ -_ _ - ----- --.`-- --- - ------- r900.17EMS REQUIRED BY LE__NDER_TO BE PAID IN ADVANCE 901__ Interest From___ - __ _t_o (a7$ , -- _____ ~t~ Idav __ _ _` I 902_Mortgag_e Insurance Premium for __ to _ ' ,__ _~ 903. Hazard Insurance Premium Jor to I 904.- --- - - -- - - ' -- '-- I _ 905 -- - - -- _ - - - - ---- ! 1000 RESERVES DEPOSITED WITH LENDER FOR i 1001. Hazard Insurance mo__@_~ - -- _-- r- - - --------- -- 1002_Morf a eInsurance mo. 0(7 $ -- !mo -- Imo ~ I - ---~ I _1_003. City Propert~Tax_-___ __, mo. (off $ _ __-_„ /mo _ _ ~ ~ 0,_1004. County Prop>~ Tax _, mo. a(7. $ __ 32.90 /mo mo. D(7. $ _ II 1005. School taxes 86.06 Imo ^,__ ~1009_Aygregale Analysis-Adjustment--- __ __ _1100. TITLE_CHARGES_ _ r 1101_ Settlement or closing fee __ _~ 0.00 0.00 I _ 1102. Abstract or title search - -~ - I _ _ _ Tiileexamination 1103. --_ __~ __ __ - __ --- -- -- - _ _ _ _ --- -- 11104 Title insurance binder _____ ~--- '_ - - ------- -- - 1105 Document Pre aration ___ __ 11 106_Notary Fees--------_.. --- - -- - --- --- -- ~ ~ I _ t 107. Attorney's fees ___- to Stone Lafaver 8 Shekletski ~ 750.00 _ -{includes above items No: __- -- 1 ------- _ _ ---- ~ I 1108. Title insurance ~- -- - - -- i r - includes above items No__ ____ -_ _____ _ ___ _____-______~_ _ i ~~ 1109. Lender's Coverage $ __ _ _ _ _ 1110_Owner's Covee<age $ _.__ 93,500.00_ 1111. -- -- - r 1112. _ _ 1113`__ _ _ _ _ _ GOVERNMENT RECORDING AND TRANSFER CHARGES 11200 __ ~ ~ I e . L1201_Recordin Fees Deedd~50.50 yMorlgage $ ;Release $ I .50.50 1202. City/County_taxlstamos _ Deed $935A0 ,Mortgage $ 935.00 ~ 1203. State Tax/stamps - Deed $935.00 Mortgage $ _, 935.00 -- 1204, 1205 T I ^____._ _ _ _ _ 1300. ADDITIONAL SETTLEMENT CHARGES I _1301_Surve~_______ ___ ____ __ 1302. Pest Ins ection ____ _ _ _ ~; 1303._Final Utilities to Carlisle Borough , 192.05 11400. DOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K1 I 1 735.50 6 887,0 HUD CERTIFICATION OF BUYER AND SELLER.-""~`~~-'""" I ha carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it ~s alrue and accurate stateme ?o(all r, eip a tl~sbursements made on my account or by me in this Iransacl on I further certify that I ave received a copy of Me HUD-1 Setllement Statement r •\` lame o r. ~-~ - ~Ta~ol ~/ r I Estate o(Arcaoe J. Plant ~ ~ 1~, ' I~..., ~`y$-~'.~J, cam-(! (3..._.Q~ ('•-h..~ . ~ - J " ~-~ ~--jl ,. Hy: RonaldT~Gertz. Execu o WARNING- IT IS A CRIME TO KNOW INGLV MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION t01p. A ..^-~. - The HUD-t Setllement Statement which I have preDaretl is true and accurate account or this transaction. I have caused or will cause the fiktds a die urs d in accortlance with this statement. J i SETTLEMENT AGENT: DATE: ~~'i i -